巩膜壳后中央间隙内羟基磷灰石义眼台植入术临床观察

目的:观察分析巩膜壳后中央间隙内一期植入羟基磷灰石义眼台的临床效果。方法:对45例(45眼)眼球内容物剜除术后的患者,于自体巩膜壳后中央间隙内一期植入羟基磷灰石义眼台,手术后随访24~36月。结果:45眼外形饱满,活动度好,无义眼台暴露、感染、巩膜溶解。结论:巩膜后中央间隙内羟基磷灰石义眼台植入术是简单、安全、有效、并发症少的眶内充填物手术。     

两种不同术式羟基磷灰石义眼座植入术的临床研究

目的:观察眼内容器剜除或眼球摘除术后,用两种不同术式眼内植入羟基磷灰石义眼座的临床治疗效果.方法:对102例有义眼座植入适应证患者分为A、B两组,A组行眼内容剜除自体巩膜壳包裹羟基磷灰石义眼座植入术,B组行眼球摘除肌锥内羟基磷灰石义眼座植入术,观察两种手术方法的远期随访效果,比较两种术式的优劣,为临床应用提供依据.结果:102例患者中(眼内容物剜除术50例、眼球摘除术52例),除4例眼球摘除患者术后3月义眼台外露,经手术治疗后痊愈外,其余患者术后义眼台运动灵活,美容效果满意.结论:对已行眼内容物剜除及眼球摘除的患者,分别采用眼内容剜除自体巩膜包裹羟基磷灰石义眼座植入术和眼球摘除肌锥内羟基磷灰石义眼座植入术,均能够取得较好的治疗效果.     

巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察

目的:巩膜四瓣法包裹羟基磷灰石义眼台植入术的临床疗效观察.方法:35例(35眼)患者行眼内容物剜除术后,鼻上下、颞上下方剪开巩膜,将巩膜分成4方瓣,剪断视神经,以视盘为中心,环行剪开后极部巩膜.自后巩膜孔前剪开巩膜近赤道部,巩膜腔后部呈4片张开.结果:术后随访3-27月,患者术后义眼座球体稳固,双眼对称,外观逼真,活动度:内转、外转达10°-15°,上转、下转达10°.无暴露、移位等发生.结论:巩膜四瓣法包裹羟基磷灰石义眼台植入术安全可行,操作简便,并发症少,义眼活动更满意,值得推广.     

37例眼内容物剜除联合羟基磷灰石义眼台植入术

目的分析眼内容物剜除联合羟基磷灰石义眼台植入术的操作方法和临床效果。方法回顾37例接受眼内容物剜除联合羟基磷灰石义眼台植入的患者,记录其资料、手术适应证及手术后并发症,探讨手术技巧和术中、术后注意事项。结果本组共37例患者,术后随访3~6个月。除1例上睑下垂合并下睑松弛、1例下睑轻度松弛下垂、1例结膜囊狭窄外,其余34例义眼外观满意,活动度良好;无义眼台暴露、感染等并发症发生。结论术中缝合筋膜可能导致结膜囊狭窄,逐层缝合巩膜和结膜可获得相同良好的术后效果;术中充分分离巩膜并将巩膜瓣翻起,是成功植入义眼台的关键;术中良好的手术操作及术后正确的处理措施对预后至关重要,应充分重视细节。     

视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术

目的 探讨视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术的临床疗效.方法 对122例患者(122只眼)随机分成A、B两组,术中均先行常规眼内容物剜除术,自颞上至鼻下象限斜行剪开巩膜全层,剖分巩膜壳为两瓣,并放置HA义眼台.两组术中处理视神经的方式不同:A组为传统球后视神经离断,B组为沿视乳头周围2 mm做圆形巩膜剪开.对术中止血时间、球结膜缝合张力、疼痛、义眼台置入后睑裂大小、手术时间;对术后疼痛、球结膜水肿和充血、义眼片佩戴时间行对比分析.结果 A、B两组术中压迫止血时间分别为(23.46±6.96) min和(5 49±1.72)min,球结膜缝合张力评分分别为3.39±0.74和0.45±0.59,手术时间分别为(79.44±10.81) min和(43.46±8.43) min;术后首日疼痛评分分别为2.8±0.68和1.47±0.67,义眼片佩戴时间分别为(6.27±2.73)周和(3.07±2.11)周.以上指标两组间差异均有统计学意义(P＜0.01).结论 与传统球后视神经离断组相比,视神经不离断的眼内容物剜除并Ⅰ期义眼台置入术具有术中损伤小、耗时短、术后疼痛轻、恢复快的优势.     

羟基磷灰石义眼台巩膜瓣后置入术美容效果分析

目的探讨羟基磷灰石义眼台巩膜瓣后置入术的美容效果。方法眼内容物剜除的患者，采用巩膜后羟基磷灰石义眼台置入术治疗。结果共治疗32例，其中眼球萎缩14例、角巩膜葡萄肿5例、绝对期青光眼3例、新生血管性青光眼3例、眼球破裂伤7例。随访3～12个月，未发现义眼台脱出、移位，置入物性能稳定、可靠，眼睑饱满，义眼活动度良好，美容效果满意。结论羟基磷灰石义眼台巩膜瓣后置入术可达到良好美容效果。     

两种义眼座在眼窝成形术的应用

目的观察两种义眼座在眼窝成形术的效果。方法眼球摘除或眼内容物剜除术后置入硅海绵义眼座10例，羟基磷灰石（HA）义眼座34例。均置入分离出的肌锥内，用双层异体或自体巩膜覆盖于义眼座前面，术后6～8个月可行钻孔手术。结果随访1～6年，硅海绵组有1例感染，3例外露脱出，3例眼窝仍轻度凹陷。HA组未出现感染、置入物脱出现象，2例手术后早期出现伤口裂开，修复后痊愈。结论HA组织相容性好，术后并发症少，在恢复眼眶内的容积，改善眼外观和加强义眼的活动等方面都令人满意，是当今眼窝成形术中较好的人工填充材料，改良的眼窝成形术是一种值得选择的手术方法。     

严重眼球破裂伤双层巩膜覆盖羟基磷灰石义眼台置入术的疗效分析

目的:探讨严重眼球破裂伤双层巩膜覆盖羟基磷灰石义眼台置入术的疗效.方法:对20例(20眼)严重眼球破裂伤缝合术后患者常规行眼内容物剜除双层巩膜覆盖羟基磷灰石义眼台置入术.术后随访12～24月.结果:20例患者术后反应轻,外观及活动度好,无义眼台暴露、脱出等并发症发生.结论:本术式术后并发症少,恢复快,能有效预防义眼台暴露,是义眼置入的理想手术方法.     

改良眼内容物剜除术在预防眼窝凹陷中的应用

目的:探讨改良眼内容物剜除术替代义眼台植入预防眼窝凹陷的方法及临床效果。方法:对36例(36)眼视力丧失患者行保留角膜的眼内容物剜除术,术中将眼内容物及色素剜除干净,剪断视神经。术后1月订做并佩戴义眼片改善外观,随访6~24个月。结果:36例(36眼)眼眶区饱满,睑裂高度双眼基本对称,义眼活动度良好。结论:改良式眼内容物剜除术操作简便,疗效好,痛苦小,费用低,并发症小,值得基层医院推广应用。     

羟基磷灰石义眼座自体巩膜腔内Ⅰ期植入的临床观察

目的：义眼座植入方法简便，矫正眼窝凹陷良好及增加义眼活动的一种手术方法。方法剜出眼内容物，将羟基磷灰石（hy－droxyapatite，HA）义眼座直接植入自体巩膜腔内，眼外肌及视神经保留，术后2～3周置入薄片义眼。结果37例术后义眼座无暴露及脱出，安装义眼活动度良好。结论此方法避免了其他方法的多种弊端，且操作简便易行，美容效果甚佳，本文就手术方法及对义眼座植入体暴露原因作了讨论。     

Effect of xenon on catecholamine and hemodynamic responses to surgical noxious stimulation in humans

STUDY OBJECTIVE: To determine the effect of xenon in combination anesthesia with sevoflurane on the catecholamine and hemodynamic responses to surgical noxious stimulation in humans. DESIGN: Randomized study. SETTING: A university hospital. PATIENTS: This study involved 32 female ASA physical status I and II patients, age 20-58 years, scheduled for abdominal hysterectomy. INTERVENTIONS: Patients were randomly divided into 4 groups: group X50-S1.5, 50% xenon and 1.5% sevoflurane; group X70-S1.5, 70% xenon and 1.5% sevoflurane; group G70-S1.5, 70% nitrous oxide and 1.5% sevoflurane; and group S2.8, 2.8% sevoflurane. No premedication was administered to the patients, and anesthesia was induced by administration of sevoflurane in oxygen and 0.10 to 0.15 mg/kg of vecuronium. After tracheal intubation, the combination of anesthetics was started, and skin incision was performed after equilibration for more than 15 minutes. MEASUREMENTS: Systolic blood pressure and heart rate (HR) were recorded, and the plasma concentrations of norepinephrine, epinephrine (E), and dopamine were measured 0, 2.5, 5, 7.5, 10, 12.5, and 15 minutes after skin incision. MAIN RESULTS: The maximal increase in the E concentration and the values of the area under the curve for E were significantly smaller in the X50-S1.5 and X70-S1.5 groups compared with that in the S2.8 group (P<0.05). At 1 minute after incision, the HR in X50-S1.5 was significantly lower than those in G70-S1.5 and S2.8 groups and the HR in X70-S1.5 was lower than that in S2.8 group (P<0.01). The systolic blood pressure in S2.8 group at 1 minute was significantly higher than those of other groups (P<0.01). CONCLUSION: Combination anesthesia using xenon and sevoflurane suppresses the plasma E concentration and hemodynamic response after skin incision more effectively than sevoflurane anesthesia alone.     

The minimum alveolar concentration (MAC) and hemodynamic effects of halothane, isoflurane, and sevoflurane in newborn swine

To determine the minimum alveolar concentration (MAC) and hemodynamic responses to halothane, isoflurane, and sevoflurane in newborn swine, 36 fasting swine 4-10 days of age were anesthetized with one of the three volatile anesthetics in 100% oxygen. MAC was determined for each swine. Carotid artery and internal jugular catheters were inserted and each swine was allowed to recover for 48 h. After recovery, heart rate (HR), systemic systolic arterial pressure (SAP), and cardiac index (CI) were measured awake and then at 0.5, 1.0, and 1.5 MAC of the designated anesthetic in random sequence. The (mean +/- SD) MAC for halothane was 0.90 +/- 0.12%; the MAC for isoflurane was 1.48 +/- 0.21%; and the MAC for sevoflurane was 2.12 +/- 0.39%. Awake (mean +/- SD) measurements of HR, SAP, and CI did not differ significantly among the three groups. Compared to the awake HR, the mean HR decreased 35% at 1.5 MAC halothane (P less than 0.001), 19% at 1.5 MAC isoflurane (P less than 0.005), and 31% at 1.5 MAC sevoflurane (P less than 0.005). Compared to awake SAP, mean SAP measurements decreased 46% at 1.5 MAC halothane (P less than 0.001), 43% at 1.5 MAC isoflurane (P less than 0.001), and 36% at 1.5 MAC sevoflurane (P less than 0.005). Mean SAP at 1.0 and 1.5 MAC halothane and isoflurane were significantly less than those measured at equipotent concentrations of sevoflurane (P less than 0.005). Compared to awake CI, mean CI measurements decreased 53% at 1.5 MAC halothane (P less than 0.001) and 43% at 1.5 MAC isoflurane (P less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)     

Kvbeta1.3 reduces the degree of stereoselective bupivacaine block of Kv1.5 channels

BACKGROUND: Kvbeta1.3 subunit modifies the gating and the pharmacology of Kv1.5 channels, decreasing their sensitivity to block induced by drugs, suggesting that Kvbeta1.3 competes with them for a binding site at Kv1.5 channels. METHODS: Currents generated by the activation of Kv1.5 and Kv1.5 + Kvbeta1.3 channels expressed in HEK293 cells and Xenopus oocytes were recorded by using whole cell patch clamp and voltage clamp techniques. RESULTS: Block of Kv1.5, but not that produced on Kv1.5 + Kvbeta1.3 channels, was voltage dependent. In both channels, bupivacaine block was time dependent. R(+)- and S(-)-bupivacaine blocked Kv1.5 with IC50 4.4 +/- 0.5 microM (n = 15) and 39.8 +/- 8.2 microM (n = 16; P < 0.05), respectively. These values increased fourfold for R(+)-bupivacaine (17.2 +/- 2.2 microM) and twofold for S(-)-bupivacaine (71.9 +/- 11.5 microM) in Kv1.5 + Kvbeta1.3 channels. Therefore, the degree of stereoselectivity (theta) decreased from 9 to 4 in the presence of Kvbeta1.3. The decrease in potency to block Kv1.5 + Kvbeta1.3 channels was the result of a less stable interaction between bupivacaine enantiomers and channels. Differences in stereoselectivity in each situation were due to a more favorable interaction between the channel and R(+)-bupivacaine. In the presence of Kvbeta1.3, stereoselectivity was abolished for V514A mutant channels (involved in bupivacaine binding but not in Kvbeta1.3 binding) but not for L510A (part of Kvbeta1.3 binding site). CONCLUSIONS: The degree of stereoselective block of Kv1.5 decreases from 9 to 4 when Kvbeta1.3 is present. L510 is determinant for the modulation of bupivacaine block, because it is the only residue of the S6 segment that binds to both bupivacaine and Kvbeta1.3. These findings support an overlapping binding site for drugs and Kvbeta1.3.     

Everolimus Versus Mycophenolate Mofetil in Heart Transplantation: A Randomized,Multicenter Trial

In an open‐label, 24‐month trial, 721 de novo heart transplant recipients were randomized to everolimus 1.5 mg or 3.0 mg with reduced‐dose cyclosporine, or mycophenolate mofetil (MMF) 3 g/day with standard‐dose cyclosporine (plus corticosteroids ± induction). Primary efficacy endpoint was the 12‐month composite incidence of biopsy‐proven acute rejection, acute rejection associated with hemodynamic compromise, graft loss/retransplant, death or loss to follow‐up. Everolimus 1.5 mg was noninferior to MMF for this endpoint at month 12 (35.1% vs. 33.6%; difference 1.5% [97.5% CI: –7.5%, 10.6%]) and month 24. Mortality to month 3 was higher with everolimus 1.5 mg versus MMF in patients receiving rabbit antithymocyte globulin (rATG) induction, mainly due to infection, but 24‐month mortality was similar (everolimus 1.5 mg 10.6% [30/282], MMF 9.2% [25/271]). Everolimus 3.0 mg was terminated prematurely due to higher mortality. The mean (SD) 12‐month increase in maximal intimal thickness was 0.03 (0.05) mm with everolimus 1.5 mg versus 0.07 (0.11) mm with MMF (p < 0.001). Everolimus 1.5 mg was inferior to MMF for renal function but comparable in patients achieving predefined reduced cyclosporine trough concentrations. Nonfatal serious adverse events were more frequent with everolimus 1.5 mg versus MMF. Everolimus 1.5 mg with reduced‐dose cyclosporine offers similar efficacy to MMF with standard‐dose cyclosporine and reduces intimal proliferation at 12 months in de novo heart transplant recipients.     

The mesh skin graft--true expansion rate

Using the mesh graft II dermatome (Zimmer) for split skin graft expansion, the 3 to 1 and 1.5 to 1 expansion rates were evaluated for true clinical expansion. In one hundred and one 1.5 to 1 expanded grafts the actual expansion was 1.2 and in sixty 3 to 1 expanded grafts, it was 1.5.     

Preliminary Experience with 3-Tesla MRI and Cushing's Disease.

Because radiographic visualization of a pituitary microadenoma is frequently difficult, we hypothesized that microadenomas associated with Cushing's disease may be better resolved and localized via acquisition with 3-Tesla (3T) compared with standard 1.5-Tesla (1.5T) magnetic resonance imaging (MRI). Five patients (four females, one male; age range, 14 to 50 years old) with endocrine and clinical confirmation of Cushing's disease underwent 1.5T and 3T MRI and corticotropin-releasing hormone stimulation/inferior petrosal sinus sampling (IPSS) as part of their preoperative evaluation. All patients underwent a transnasal trans-sphenoidal pituitary adenomectomy. In two cases, tumor could not be localized on either 1.5T or 3T MRI on the initial radiologist's review. In two other cases, the 1.5T images delineated the tumor location, but it was more clearly defined on 3T MRI. In a fifth case, the 1.5T MRI showed a probable right-sided adenoma. However, on both 3T MRI and at surgical exploration the tumor was localized on the left side. Therefore, in three of five cases, 3T MRI either more clearly defined tumors seen on 1.5T MRI or predicted the location of tumor contrary to the 1.5T images. IPSS identified the correct side of the tumor in two patients, an incorrect location in two patients, and was indeterminate in one patient. In certain cases 3T MRI is a new tool that may ameliorate imaging difficulties associated with adrenocorticotrophic hormone-secreting pituitary adenomas. Its role in the diagnostic evaluation of Cushing's disease will be better defined with further experience.     

Fentanyl administration during sevoflurane anesthesia suppresses spike waves from epileptic focus on electrocorticogram

A 36-year-old man with intractable epileptic seizures underwent insertion of subdural electrodes on bilateral temporal lobes under air-oxygen-sevoflurane anesthesia. After the completion of the operation, we measured electrocorticogram at end-tidal sevoflurane concentration of 2.5%, 1.5%, and 1.5% with 0.1 mg intravenous fentanyl. When sevoflurane concentration was reduced to 1.5%, the incidence and voltage of the spike waves on electrocorticogram were reduced. When 0.1 mg fentanyl was intravenously administrated during 1.5% sevoflurane anesthesia, the frequency of the spike waves was further reduced. Caution should be taken when using sevoflurane-fentanyl anesthesia because this combination may interrupt identification of epileptic focus on intraoperative electrocorticogram.     

THE EFFECT OF VARYING INSPIRATORY: EXPIRATORY RATIOS ON GAS EXCHANGE DURING ANAESTHESIA FOR OPEN-HEART SURGERY

Measurements of physiological deadspace/tidal volume ratio (VD/VTper cent) and alveolar-arterial oxygen tension difference (A-aPo₂)were made during mechanical ventilation in patients undergoingopen-heart surgery. The inspiratory: expiratory time ratiosstudied were 0.5:2.5 and 1.5:1.5 before perfusion and 0.5:2.5,1:2 and 1.5:1.5 after perfusion. Pre-perfusion there were nosignificant differences in VD/VT or A-aPo₂ between the two patternsof ventilation. Post-perfusion the A-aPo₂ increased. Althoughthere were no significant differences in A-aPo₂ between anyof the three ratios examined after perfusion, the VD/VT percent was significantly less when the inspiratory time was 1.5seconds than when it was 0.5 or 1.0 second.     

Kvβ1.3 Reduces the Degree of Stereoselective Bupivacaine Block of Kv1.5 Channels

Background: Kv[beta]1.3 subunit modifies the gating and the pharmacology of Kv1.5 channels, decreasing their sensitivity to block induced by drugs, suggesting that Kv[beta]1.3 competes with them for a binding site at Kv1.5 channels.

Methods: Currents generated by the activation of Kv1.5 and Kv1.5 + Kv[beta]1.3 channels expressed in HEK293 cells and Xenopus oocytes were recorded by using whole cell patch clamp and voltage clamp techniques.

Results: Block of Kv1.5, but not that produced on Kv1.5 + Kv[beta]1.3 channels, was voltage dependent. In both channels, bupivacaine block was time dependent. R(+)- and S(-)-bupivacaine blocked Kv1.5 with IC50 4.4 +/- 0.5 [mu]m (n = 15) and 39.8 +/- 8.2 [mu]m (n = 16; P < 0.05), respectively. These values increased fourfold for R(+)-bupivacaine (17.2 +/- 2.2 [mu]m) and twofold for S(-)-bupivacaine (71.9 +/- 11.5 [mu]m) in Kv1.5 + Kv[beta]1.3 channels. Therefore, the degree of stereoselectivity ([theta]) decreased from 9 to 4 in the presence of Kv[beta]1.3. The decrease in potency to block Kv1.5 + Kv[beta]1.3 channels was the result of a less stable interaction between bupivacaine enantiomers and channels. Differences in stereoselectivity in each situation were due to a more favorable interaction between the channel and R(+)-bupivacaine. In the presence of Kv[beta]1.3, stereoselectivity was abolished for V514A mutant channels (involved in bupivacaine binding but not in Kv[beta]1.3 binding) but not for L510A (part of Kv[beta]1.3 binding site).     

Inhalation Anesthetics Induce Apoptosis in Normal Peripheral Lymphocytes In Vitro

Background : The authors hypothesized that perioperative lymphocytopenia is partially caused by apoptosis of lymphocytes induced by inhalation anesthetics. Therefore, they evaluated whether sevoflurane and isoflurane induce apoptosis of normal peripheral lymphocytes.

Methods : Normal peripheral blood mononuclear cells were exposed to sevoflurane and isoflurane, and the percentages of apoptotic lymphocytes was measured by Annexin V-fluorescein isothiocyanate-7-amino actinomycin D flow cytometry after 24 h of exposure (0.5, 1.0, and 1.5 mm) and after 6, 12, and 24 h of exposure (1.5 mm). The percentages of lymphocytes with caspase 3-like activity were also measured after 24 h of exposure (1.5 mm).

Results : The percentages of apoptotic lymhocytes were increased in a dose-dependent manner (controls: 5.1 +/- 1.4%; sevo-flurane: 7.3 +/- 1.3% [0.5 mm], 9.1 +/- 1.5% [1.0 mm], 12.6 +/- 2.1% [1.5 mm]; isoflurane: 7.5 +/- 1.6% [0.5 mm], 10.5 +/- 1.5% [1.0 mm], 16.3 +/- 2.7% [1.5 mm]) after 24 h of exposure and in a time-dependent manner (controls: 1.2 +/- 0.4% [6 h], 3.4 +/- 0.7% [12 h], 5.6 +/- 1.2% [24 h]; sevoflurane: 1.8 +/- 0.4% [6 h], 6.4 +/- 1.2% [12 h], 11.3 +/- 2.2% [24 h]; isoflurane: 2.6 +/- 0.5% [6 h], 8.8 +/- 1.5% [12 h],16.0 +/- 1.9% [24 h]) at the concentration of 1.5 mm. The percentages of lymphocytes with caspase 3-like activity were increased (controls: 10.0 +/- 1.1%; sevoflurane: 13.8 +/- 1.2%; isoflurane: 17.0 +/- 1.3%).